Professional Documents
Culture Documents
1. Which of the following actions is the first priority of care for a client exhibiting
signs and symptoms of coronary artery disease?
1. Decrease anxiety
2. Enhance myocardial oxygenation
3. Administer sublingual nitroglycerin
4. Educate the client about his symptoms
1. Cardiac catheterization
2. Coronary artery bypass surgery
3. Oral medication therapy
4. Percutaneous transluminal coronary angioplasty
1. Chest pain
2. Dyspnea
3. Edema
4. Palpitations
4. Which of the following symptoms is the most likely origin of pain the client
described as knifelike chest pain that increases in intensity with inspiration?
1. Cardiac
2. Gastrointestinal
3. Musculoskeletal
4. Pulmonary
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
1. Aneurysm
2. Heart failure
3. Coronary artery thrombosis
4. Renal failure
1. Ventricular dilation
2. Systemic hypertension
3. Aortic valve malfunction
4. Increased atrial contractions
1. Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG
1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Narcotics
4. Nitrates
1. Cardiogenic shock
2. Heart failure
3. arrhythmias
4. Pericarditis
13. With which of the following disorders is jugular vein distention most
prominent?
14. Toxicity from which of the following medications may cause a client to see a
green-yellow halo around lights?
1. Digoxin
2. Furosemide (Lasix)
3. Metoprolol (Lopressor)
4. Enalapril (Vasotec)
15. Which of the following symptoms is most commonly associated with left-
sided heart failure?
1. Crackles
2. Arrhythmias
3. Hepatic engorgement
4. Hypotension
16. In which of the following disorders would the nurse expect to assess sacral
edema in a bedridden client?
1. Diabetes
2. Pulmonary emboli
3. Renal failure
4. Right-sided heart failure
17. Which of the following symptoms might a client with right-sided heart failure
exhibit?
1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Diuretics
4. Inotropic agents
1. Bradycardia
2. Tachycardia
3. Hypotension
4. Decreased myocardial contractility
20. Which of the following conditions is most closely associated with weight gain,
nausea, and a decrease in urine output?
1. Angina pectoris
2. Cardiomyopathy
3. Left-sided heart failure
4. Right-sided heart failure
1. Cardiomyopathy
2. Coronary artery disease
3. Myocardial infarction
4. Pericardial effusion
1. Dilated
2. Hypertrophic
3. Myocarditis
4. Restrictive
1. Congestive
2. Dilated
3. Hypertrophic
4. Restrictive
24. Which of the following recurring conditions most commonly occurs in clients
with cardiomyopathy?
1. Heart failure
2. Diabetes
3. MI
4. Pericardial effusion
25. Dyspnea, cough, expectoration, weakness, and edema are classic signs and
symptoms of which of the following conditions?
1. Pericarditis
2. Hypertension
3. MI
4. Heart failure
26. In which of the following types of cardiomyopathy does cardiac output
remain normal?
1. Dilated
2. Hypertrophic
3. Obliterative
4. Restrictive
27. Which of the following cardiac conditions does a fourth heart sound (S4)
indicate?
1. Dilated aorta
2. Normally functioning heart
3. Decreased myocardial contractility
4. Failure of the ventricle to eject all of the blood during systole
28. Which of the following classes of drugs is most widely used in the treatment
of cardiomyopathy?
1. Antihypertensives
2. Beta-adrenergic blockers
3. Calcium channel blockers
4. Nitrates
1. Cardiac catheterization
2. Coronary artery bypass graft (CABG)
3. Heart transplantation
4. Intra-aortic balloon pump (IABP)
1. Anxiety
2. Stable angina
3. Unstable angina
4. Variant angina
31. Which of the following types of angina is most closely related with an
impending MI?
1. Angina decubitus
2. Chronic stable angina
3. Nocturnal angina
4. Unstable angina
32. Which of the following conditions is the predominant cause of angina?
1. Increased preload
2. Decreased afterload
3. Coronary artery spasm
4. Inadequate oxygen supply to the myocardium
33. Which of the following tests is used most often to diagnose angina?
1. Chest x-ray
2. Echocardiogram
3. Cardiac catheterization
4. 12-lead electrocardiogram (ECG)
34. Which of the following results is the primary treatment goal for angina?
1. Reversal of ischemia
2. Reversal of infarction
3. Reduction of stress and anxiety
4. Reduction of associated risk factors
35. Which of the following interventions should be the first priority when
treating a client experiencing chest pain while walking?
37. Which of the following positions would best aid breathing for a client with
acute pulmonary edema?
38. Which of the following blood gas abnormalities is initially most suggestive of
pulmonary edema?
1. Anoxia
2. Hypercapnia
3. Hyperoxygenation
4. Hypocapnia
1. Decreased BP
2. Alteration in LOC
3. Decreased BP and diuresis
4. Increased BP and fluid retention
40. Which of the following actions is the appropriate initial response to a client
coughing up pink, frothy sputum?
41. Which of the following terms describes the force against which the ventricle
must expel blood?
1. Afterload
2. Cardiac output
3. Overload
4. Preload
42. Acute pulmonary edema caused by heart failure is usually a result of damage
to which of the following areas of the heart?
1. Left atrium
2. Right atrium
3. Left ventricle
4. Right ventricle
43. An 18-year-old client who recently had an URI is admitted with suspected
rheumatic fever. Which assessment findings confirm this diagnosis?
44. A client admitted with angina complains of severe chest pain and suddenly
becomes unresponsive. After establishing unresponsiveness, which of the
following actions should the nurse take first?
1. Anxiety
2. Ineffective tissue perfusion; cardiopulmonary
3. Acute pain
4. Ineffective therapeutic regimen management
46. A client comes into the E.R. with acute shortness of breath and a cough that
produces pink, frothy sputum. Admission assessment reveals crackles and
wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38
breaths/minute. The client’s medical history included DM, HTN, and heart
failure. Which of the following disorders should the nurse suspect?
1. Pulmonary edema
2. Pneumothorax
3. Cardiac tamponade
4. Pulmonary embolus
47. The nurse coming on duty receives the report from the nurse going off duty.
Which of the following clients should the on-duty nurse assess first?
1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of
126/76, and a respiratory rate of 21 breaths a minute.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a
DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis and
receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation
and is receiving IV diltiazem (Cardizem).
48. When developing a teaching plan for a client with endocarditis, which of the
following points is most essential for the nurse to include?
49. A nurse is conducting a health history with a client with a primary diagnosis
of heart failure. Which of the following disorders reported by the client is
unlikely to play a role in exacerbating the heart failure?
1. Recent URI
2. Nutritional anemia
3. Peptic ulcer disease
4. A-Fib
50. A nurse is preparing for the admission of a client with heart failure who is
being sent directly to the hospital from the physician’s office. The nurse would
plan on having which of the following medications readily available for use?
1. Diltiazem (Cardizem)
2. Digoxin (Lanoxin)
3. Propranolol (Inderal)
4. Metoprolol (Lopressor)
51. A nurse caring for a client in one room is told by another nurse that a second
client has developed severe pulmonary edema. On entering the 2nd client’s
room, the nurse would expect the client to be:
1. Slightly anxious
2. Mildly anxious
3. Moderately anxious
4. Extremely anxious
52. A client with pulmonary edema has been on diuretic therapy. The client has
an order for additional furosemide (Lasix) in the amount of 40 mg IV push.
Knowing that the client also will be started on Digoxin (Lanoxin), a nurse checks
the client’s most recent:
1. Digoxin level
2. Sodium level
3. Potassium level
4. Creatinine level
53. A client who had cardiac surgery 24 hours ago has a urine output averaging
19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid.
Urine output for the subsequent hour was 25 ml. Daily laboratory results
indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2
mg/dL. A nurse interprets the client is at risk for:
1. Hypovolemia
2. UTI
3. Glomerulonephritis
4. Acute renal failure
54. A nurse is preparing to ambulate a client on the 3rd day after cardiac
surgery. The nurse would plan to do which of the following to enable the client to
best tolerate the ambulation?
57. A home care nurse is making a routine visit to a client receiving digoxin
(Lanoxin) in the treatment of heart failure. The nurse would particularly assess
the client for:
58. A client with angina complains that the angina pain is prolonged and severe
and occurs at the same time each day, most often in the morning, On further
assessment a nurse notes that the pain occurs in the absence of precipitating
factors. This type of anginal pain is best described as:
1. Stable angina
2. Unstable angina
3. Variant angina
4. Nonanginal pain
59. The physician orders continuous intravenous nitroglycerin infusion for the
client with MI. Essential nursing actions include which of the following?
1. Antipyretic action
2. Antithrombotic action
3. Antiplatelet action
4. Analgesic action
61. Which of the following is an expected outcome for a client on the second day
of hospitalization after an MI?
62. Which of the following reflects the principle on which a client’s diet will most
likely be based during the acute phase of MI?
1. Liquids as ordered
2. Small, easily digested meals
3. Three regular meals per day
4. NPO
63. An older, sedentary adult may not respond to emotional or physical stress as
well as a younger individual because of:
64. Which of the following nursing diagnoses would be appropriate for a client
with heart failure? Select all that apply.
65. Which of the following would be a priority nursing diagnosis for the client
with heart failure and pulmonary edema?
1. Vasopressor
2. Volume expander
3. Vasodilator
4. Potassium-sparing diuretic
67. Furosemide is administered intravenously to a client with HF. How soon
after administration should the nurse begin to see evidence of the drugs desired
effect?
1. 5 to 10 minutes
2. 30 to 60 minutes
3. 2 to 4 hours
4. 6 to 8 hours
68. Which of the following foods should the nurse teach a client with heart
failure to avoid or limit when following a 2-gram sodium diet?
1. Apples
2. Tomato juice
3. Whole wheat bread
4. Beef tenderloin
69. The nurse finds the apical pulse below the 5th intercostal space. The nurse
suspects:
70. Which of the following arteries primarily feeds the anterior wall of the heart?
1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery
Gauge your performance by counter checking your answers to the answers below.
Learn more about the question by reading the rationale. If you have any disputes or
questions, please direct them to the comments section.
Enhancing myocardial oxygenation is always the first priority when a client exhibits
signs or symptoms of cardiac compromise. Without adequate oxygenation, the
myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute
angina, but administration isn’t the first priority. Although educating the client and
decreasing anxiety are important in care delivery, neither are priorities when a client
is compromised.
4. Answer: 4. Pulmonary
5. Answer: 3. Troponin I
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury.
Troponin I levels aren’t detectable in people without cardiac injury. Lactate
dehydrogenase (LDH) is present in almost all body tissues and not specific to heart
muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to
review blood counts, and a complete chemistry is obtained to review electrolytes.
Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required
to detect cardiac injury.
Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased
atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic
valve malfunction is heard as a murmur.
Administering supplemental oxygen to the client is the first priority of care. The
myocardium is deprived of oxygen during an infarction, so additional oxygen is
administered to assist in oxygenation and prevent further damage. Morphine and nitro
are also used to treat MI, but they’re more commonly administered after the oxygen.
An ECG is the most common diagnostic tool used to evaluate MI.
Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common
complication of an MI. Cardiogenic shock, another complication of an MI, is defined
as the end stage of left ventricular dysfunction. This condition occurs in
approximately 15% of clients with MI. Because the pumping function of the heart is
compromised by an MI, heart failure is the second most common complication.
Pericarditis most commonly results from a bacterial or viral infection but may occur
after the MI.
One of the most common signs of digoxin toxicity is the visual disturbance known as
the “green-yellow halo sign.” The other medications aren’t associated with such an
effect.
The most accurate area on the body to assess dependent edema in a bed-ridden client
is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart
failure.
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads
to fluid retention, which causes oliguria.
Inotropic agents are administered to increase the force of the heart’s contractions,
thereby increasing ventricular contractility and ultimately increasing cardiac output.
Weight gain, nausea, and a decrease in urine output are secondary effects of right-
sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided
heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather
than systemic ones. Angina pectoris doesn’t cause weight gain, nausea, or a decrease
in urine output.
Although the cause isn’t entirely known, cardiac dilation and heart failure may
develop during the last month of pregnancy or the first few months after birth. The
condition may result from a preexisting cardiomyopathy not apparent prior to
pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles
that has an unknown etiology but a strong familial tendency. Myocarditis isn’t
specifically associated with childbirth. Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause is usually myocardial.
Because the structure and function of the heart muscle is affected, heart failure most
commonly occurs in clients with cardiomyopathy. MI results from prolonged
myocardial ischemia due to reduced blood flow through one of the coronary arteries.
Pericardial effusion is most predominant in clients with pericarditis.
These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness
in the chest and auscultation of a pericardial friction rub. Hypertension is usually
exhibited by headaches, visual disturbances, and a flushed face. MI causes heart
failure but isn’t related to these symptoms.
Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the
ventricle remains relatively unchanged. All of the rest decrease cardiac output.
27. Answer: 4. Failure of the ventricle to eject all of the blood during systole
The pain of stable angina is predictable in nature, builds gradually, and quickly
reaches maximum intensity. Unstable angina doesn’t always need a trigger, is more
intense, and lasts longer than stable angina. Variant angina usually occurs at rest—not
as a result of exercise or stress.
The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with
variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart
enlargement or signs of heart failure, but isn’t used to diagnose angina.
The initial priority is to decrease the oxygen consumption; this would be achieved by
sitting the client down. An ECG can be obtained after the client is sitting down. After
the ECGm sublingual nitro would be administered. When the client’s condition is
stabilized, he can be returned to bed.
The body compensates for a decrease in cardiac output with a rise in BP, due to the
stimulation of the sympathetic NS and an increase in blood volume as the kidneys
retain sodium and water. Blood pressure doesn’t initially drop in response to the
compensatory mechanism of the body. Alteration in LOC will occur only if the
decreased cardiac output persists.
Afterload refers to the resistance normally maintained by the aortic and pulmonic
valves, the condition and tone of the aorta, and the resistance offered by the systemic
and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart
per minute. Overload refers to an abundance of circulating volume. Preload is the
volume of blood in the ventricle at the end of diastole.
The left ventricle is responsible for the majority of force for the cardiac output. If the
left ventricle is damaged, the output decreases and fluid accumulates in the interstitial
and alveolar spaces, causing pulmonary edema. Damage to the left atrium would
contribute to heart failure but wouldn’t affect cardiac output or, therefore, the onset of
pulmonary edema. If the right atrium and right ventricle were damaged, right-sided
heart failure would result.
Diagnosis of rheumatic fever requires that the client have either two major Jones
criteria or one minor criterion plus evidence of a previous streptococcal infection.
Major criteria include carditis, polyarthritis, Sydenham’s chorea, subcutaneous
nodules, and erythema marginatum (transient, non pruritic macules on the trunk or
inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia,
elevated levels of acute phase reactants, and a prolonged PR-interval on ECG.
44. Answer: 1. Activate the resuscitation team
SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy
sputum are late signs of pulmonary edema.
47. Answer: 4. A 76-year-old client who was admitted 1 hour ago with new-onset
atrial fibrillation and is receiving IV diltiazem (Cardizem).
The client with A-fib has the greatest potential to become unstable and is on IV
medication that requires close monitoring. After assessing this client, the nurse should
assess the client with thrombophlebitis who is receiving a heparin infusion, and then
go to the 58-year-old client admitted 2-days ago with heart failure (her s/s are
resolving and don’t require immediate attention). The lowest priority is the 89-year-
old with end stage right-sided heart failure, who requires time consuming supportive
measures.
48. Answer: 1. “Report fever, anorexia, and night sweats to the physician.”
The most essential teaching point is to report signs of relapse, such as fever, anorexia,
and night sweats, to the physician. To prevent further endocarditis episodes,
prophylactic antibiotics are taken before and sometimes after dental work, childbirth,
or GU, GI, or gynecologic procedures. A potassium-rich diet and daily pulse
monitoring aren’t necessary for a client with endocarditis.
Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate
through a variety of mechanisms. Digoxin is the medication of choice to treat heart
failure. Diltiazem (calcium channel blocker) and propranolol and metoprolol (beta
blockers) have a negative inotropic effect and would worsen the failing heart.
Pulmonary edema causes the client to be extremely agitated and anxious. The client
may complain of a sense of drowning, suffocation, or smothering.
The serum potassium level is measured in the client receiving digoxin and
furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the
client with hypokalemia. Hypokalemia also predisposes the client to ventricular
dysrhythmias.
The client who undergoes cardiac surgery is at risk for renal injury from poor
perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal
insult is signaled by decreased urine output, and increased BUN and creatinine levels.
The client may need medications such as dopamine (Intropin) to increase renal
perfusion and possibly could need peritoneal dialysis or hemodialysis.
The nurse should encourage regular use of pain medication for the first 48 to 72 hours
after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen
consumption resulting from pain, and allow better participation in activities such as
coughing, deep breathing, and ambulation. Options 1 and 3 will not help in tolerating
ambulation. Removal of telemetry equipment is contraindicated unless prescribed.
The first signs and symptoms of digoxin toxicity in adults include abdominal pain,
N/V, visual disturbances (blurred, yellow, or green vision, halos around lights),
bradycardia, and other dysrhythmias.
IV nitro infusion requires an infusion pump for precise control of the medication. BP
monitoring would be done with a continuous system, and more frequently than every
4 hours. Hourly urine outputs are not always required. Obtaining serum potassium
levels is not associated with nitroglycerin infusion.
Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary
reason ASA is administered to the client experiencing an MI is its antithrombotic
action.
In older adults who are less active and do not exercise the heart muscle, atrophy can
result. Disuse or deconditioning can lead to abnormal changes in the myocardium of
the older adult. As a result, under sudden emotional or physical stress, the left
ventricle is less able to respond to the increased demands on the myocardial muscle.
Activity intolerance is a primary problem for clients with heart failure and pulmonary
edema. The decreased cardiac output associated with heart failure leads to reduced
oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client
could be at risk for infection related to stasis of secretions or impaired skin integrity
related to pressure. However, these are not the priority nursing diagnoses for the client
with HF and pulmonary edema, nor is constipation related to immobility.
ACE inhibitors have become the vasodilators of choice in the client with mild to
severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve
survival in overt heart failure.
Canned foods and juices, such as tomato juice, are typically high in sodium and
should be avoided in a sodium-restricted diet.
A normal apical impulse is found under over the apex of the heart and is typically
located and auscultated in the left fifth intercostal space in the midclavicular line. An
apical impulse located or auscultated below the fifth intercostal space or lateral to the
midclavicular line may indicate left ventricular enlargement.
The left anterior descending artery is the primary source of blood for the anterior wall
of the heart. The circumflex artery supplies the lateral wall, the internal mammary
artery supplies the mammary, and the right coronary artery supplies the inferior wall
of the heart.